1. A 13-year-old female patient presented with a swelling on the right side of her face that had gradually increased in size over eight months. She had sickle cell disease like her mother. 2. Clinical and radiographic examination found a cystic swelling involving teeth 12-15. Fine needle aspiration cytology was performed. 3. Histopathological examination of the excised cyst lining confirmed it was an odontogenic keratocyst, which has a high recurrence rate if not properly treated with peripheral ostectomy and Carnoy's solution.

1. 1
Dr. Manoranjan Mahakur
1st year MDS
Department of Pedodontics & Preventive Dentistry,
SCB Dental College , Cuttack -7, Odisha.

2. 2
 13 year old female
patient.
 Complains of swelling
in right side of face
since eight months.
 Swelling gradually
increased in size, non
tender.

3. 3
 SCD (trait)
 Mother had SCD
PAST MEDICAL AND FAMILY HISTORY

4. 4
 SCD (trait)
 Mother had SCD
PAST MEDICAL AND FAMILY HISTORY

5. 5
General-
 Ambulatory, conscious
 Icterus present,
 Po,Cyo,Clo
 Vital signs:
BP- 118/74 mm of Hg
Pulse- 88 bpm
Respiratory rate- 14/min
Temperature- 98.6⁰F

6. 6
FEATURES EXTRA-ORAL INTRA ORAL
LOCATION, SHAPE,
SIZE, MARGIN
Swelling was extending
from right corner of
mouth to middle of the
ala-canthus line.
Swelling in right buccal
plate extending from 11 to
16 teeth region.
, margin diffuse
CONSISTENCY Firm & hard Firm, non-compressible
TENDERNESS Crepitus present Non-tender
PUS DISCHARGE Absent Absent
LYMPH NODES Not-palpable

7. 7
Teeth present
16,56,14,53,12,11,21,62,22,63,64,65,26
46,85,84,83,43,41,31,32,73,74,75,36

8. 8
 OPG
 IOPA 11.12.13.14.15
 FNAC

9. 9
CYSTIC SWELLING WITH IMPACTED 13

10. 10
WELL DEFINED RADIOLUSCENT REGION

11. 11

12. 12
DENTIGEROUS
CYST
OKC
AOT

13. 13

14. 14
TREATMENT PLANNING
ENUCLEATION MARSUPILISATION

15. 15
BLOOD INVESTIGATION
CBC= NAD
BT,CT= NAD
INR= 1.2
SERUM BILIRUBIN = 1.5 (elevated
due to SCD)
URINE RE/ME =NAD

16. 16

17. 17

18. 18

19. 19

20. 20

21. 21
FLAP RETRACTION

22. 22
RUPTURE OF CYST

23. 23
ENUCLEATION OF CYST

24. 24

25. 25

26. 26

27. 27
C
A
N
I
N
E
S
H
O
C
K
E
T

28. 28

29. 29

30. 30

31. 31

32. 32

33. 33
 Received g/w soft tissue
specimen resembling like
cystic sac enclosing teeth
12,53,14,13, crown of canine
was inside the sac
measuring about 3.5x3 cm.

34. 34
Epithelial lining is
uniformly thin
Ranging from 8-10 cell
layer thick.

35. 35
Luminal
epithelial cell are
parakeratinized
Produce an
uneven or
corrugated profile
Lumen is filled
with keratin flecks.

36. 36
Distinctive basal
laser
Parakeratosis
,corrugated surface
exhibit a
characteristic
palisaded pattern
with polarised &
hyperchromatic

37. 37
The surface does
not show
prominent
corrugation but
show distinct
hyperchromatic
basal layer.

38. 38
Epithelial lining is
separated from
underlying stroma
(Most likely to be
seen in OKC).

39. 39

40. 40

41. 41
 The term OKC was first used by Philipsen in 1956.
 Pindborg & Hansen in 1963 described the essential
features of this type of cyst.
 In 1967, Toller suggested that the OKC may best be
regarded as a benign neoplasm.
 In 2005, the WHO reclassified OKC & labelled it
Keratocystic Odontogenic Tumor.
 Status in 2017 Classification it was renamed as
Odontogenic keratocyst and classified under
Odontogenic cysts.

42. 42
 Cholesteatoma (Hauer, 1926; Kostecka,
1929)
 ‘Primordial cyst’ (Shear, 1960a; Shear and
Altini, 1976; Pindborg et al.,1971)
 ‘Keratocystoma’ (2003, Shear)
 ‘Keratinising cystic odontogenic tumour’
(Reichart and Philipsen, 2004)

43. 43
PREMORDIAL
(60%)
DENTAL
LAMINA
RESTS
BASAL CELLS
OF ORAL
EPITHELIUM
DENTIGEROUS
(40%)
REE

44. 44
 Age between 10 and 40 years.
 Slight male predilection.

45. 45
 Tend to grow in an anteroposterior direction
within the medullary cavity of the bone
without causing obvious bone expansion.
 It demonstrates a well-defined radiolucent area
with smooth and often corticated margins.
 An un erupted tooth is involved in the lesion in
25% to 40% of cases- the cyst has presumably
arisen from dental lamina rests near an un erupted
tooth and has grown to envelop the un erupted
tooth.
 Resorption of the roots of erupted teeth
adjacent to it is less common.

46. 46
 Recurrence rate of approximately 30%.
 More often in mandibular odontogenic keratocysts,
particularly those in the posterior body and
ascending ramus.
 Recur within 5 years of the original surgery.
Many surgeons recommend
1. Peripheral ostectomy of the bony cavity with a
bone bur to reduce the frequency of recurrence.
2. Chemical cauterization of the bony cavity with
Carnoy’s solution after cyst removal.

47. 47
 Oral and Maxillofacial pathology, R. E. Marx , D. Stern
 Oral and Maxillofacial Pathology, B.W.Neville, D.D.Damm,
C.M.Allen, A.Chi
 Textbook of Oral Pathology, Shafer, Hine, Levy
 Head & neck pathology, Robert A.Robinson
 Barreto, D.C., Gomez, R.S., Bale, A.E., Boson, W.L. and De
Marco, L. (2000) PTCH Gene Mutations in Odontogenic
Keratocysts. Journal of Dental Research.
 Praetorius, F. and Ledesma-Montes, C. (2005)
Dentinogenic Ghost Cell Tumour. In: Barnes, L., Eveson,
J.W., Reichart, P. and Sidansky, D., Eds., World Health
Organization Classification of Tumor. Pathology and
Genetics of Head and Neck Tumours. IARC Press, Lyon, 314.

48. 48

49. 49
“I will not be ashamed to say "I know not," nor will I fail
to call in my colleagues when the skills of another are
needed for a patient's recovery”.
( Hippocratic oath line 4 )